Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, Turkey.
Department of Ear-Nose-Throat, Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, Turkey.
Cardiol Young. 2021 Sep;31(9):1484-1488. doi: 10.1017/S1047951121001657. Epub 2021 May 4.
After congenital heart surgery, some patients may need long-term mechanical ventilation because of chronic respiratory failure. In this study, we analysed outcomes of the patients who need tracheostomy and home mechanical ventilation.
Amongst 1343 patients who underwent congenital heart surgery between January, 2014 and June, 2018, 45 needed tracheostomy and HMV. The median age of these patients was 6.4 months (12 days-6.5 years). Nineteen patients underwent palliation while 26 patients underwent total repair. Post-operative diaphragm plication was performed in five patients (11%). Median duration of mechanical ventilation before tracheostomy was 32 days (8-154 days). The patients were followed up with their home ventilators in ward and at home. Mean follow-up time was 36.24 ± 11.61 months.
The median duration of ICU stay after tracheostomy was 27 days (range 2-93 days). Follow-up time in ward was median 30 days (2-156 days). A total of 12 patients (26.6%) were separated from the ventilator and underwent decannulation during hospital stay. Thirty-two patients (71.1%) were discharged home with home ventilator support. Of them, 15 patients (46.9%) were separated from the respiratory support in median of 6 weeks (1 week-11 months) and decannulations were performed. Total mortality was 31.1%. in which four patients are still HMV dependent. There was no significant difference for decannulation between total repair and palliation patients.
HMV via tracheostomy is a useful option for the treatment of children who are dependent on long-term ventilation after congenital heart surgery although there are potential risks.
先天性心脏病手术后，部分患者可能因慢性呼吸衰竭而需要长期机械通气。本研究分析了需要气管切开和家庭机械通气的患者的结局。
在 2014 年 1 月至 2018 年 6 月期间接受先天性心脏病手术的 1343 名患者中，有 45 名需要气管切开和 HMV。这些患者的中位年龄为 6.4 个月（12 天至 6.5 岁）。19 名患者接受姑息治疗，26 名患者接受根治性手术。5 名患者（11%）行膈肌折叠术。气管切开前机械通气中位时间为 32 天（8-154 天）。患者在病房和家中使用家用呼吸机进行随访。平均随访时间为 36.24±11.61 个月。
气管切开后 ICU 中位住院时间为 27 天（范围 2-93 天）。病房中位随访时间为 30 天（2-156 天）。共有 12 名患者（26.6%）在住院期间成功脱离呼吸机并拔管。32 名患者（71.1%）带家用呼吸机出院。其中 15 名患者（46.9%）在中位 6 周（1 周-11 个月）后成功脱离呼吸支持并拔管。总死亡率为 31.1%。其中 4 名患者仍依赖 HMV。根治性手术和姑息性手术患者的拔管率无显著差异。
尽管存在潜在风险，但气管切开家庭机械通气是治疗先天性心脏病手术后长期依赖机械通气的儿童的有效选择。
